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Journal of Child & Adolescent Trauma (2024) 17:939–955
https://doi.org/10.1007/s40653-024-00634-5
ORIGINAL ARTICLE
The Outcomes ofTrauma‑Informed Practice inYouth Justice:
AnUmbrella Review
CatiaG.Malvaso1,2· AndrewDay3,4· CarolynM.Boyd1
Accepted: 15 March 2024 / Published online: 22 April 2024
© The Author(s) 2024
Abstract
Findings of high rates of complex trauma among justice-involved young people have engendered interest in developing trauma-
informed youth justice systems. Although there have been several reviews of trauma-informed practice in youth justice
settings, uncertainty remains about whether this approach can produce the outcomes expected of youth justice services. In
this study we summarize findings from recent systematic reviews and meta-analyses to provide an overview of evidence
relevant to implementing trauma-informed youth justice. We conducted an umbrella review of systematic reviews published
between 2017 and 2023 that included group-based primary studies of trauma-informed interventions for justice-involved
young people. Reviews were located via searches of PsycINFO, PubMedCentral, Embase, Criminal Justice Abstracts with Full Text,
and ProQuest. Data extracted from each review included the number and type of primary studies reviewed, and outcomes
related to trauma symptomatology, mental health and wellbeing, and justice system involvement. Nine systematic reviews met
our inclusion criteria. Improvements in trauma symptoms, mental health and wellbeing, and justice system involvement were
documented in each review. The strongest evidence related to the impact of trauma-focused interventions on posttraumatic
stress disorder symptoms, but less evidence was available to demonstrate outcomes of organizational level and systemic
components of trauma-informed practice. Each review highlighted the need to strengthen the methodological quality of
primary studies. Trauma-informed practice should be seriously considered as part of any effort to implement evidence-
based youth justice. This should extend beyond treatment of trauma symptomatology to incorporate a broader approach to
trauma-informed practice that is organizationally embedded.
Keywords Trauma-informed· Trauma-focused· Youth justice· Outcomes· Umbrella review· Overview
Youth justice services around the western world have, in
recent years, found themselves under increasing pressure to
develop new and more effective ways of working. A series
of reviews, inquiries, and investigations (e.g., the Carlile
Inquiry, 2014; Clancey etal., 2020; Knox etal., 2013; RCP-
DCNT, 2017) have highlighted harmful and abusive prac-
tice, reigniting long-standing debates about the purpose of
a youth justice system (e.g., Braithwaite & Mugford, 1994;
Day, 2023) and identifying a need to develop practices that
are evidence-informed and less punitive. It is in this context
that the idea of ‘trauma-informed practice’ has emerged as
a potentially promising way to develop new policies, pro-
grams, and interventions that can help to achieve better
outcomes for children and young people while, at the same
time, also ensuring the safety of the community. Indeed, a
number of youth justice agencies around the world have now
endorsed a trauma-informed approach (e.g., Jackson etal.,
2023), even though it has been observed that terms such
as ‘trauma-informed practice’ (TIP) and ‘trauma-informed
care’ (TIC) often lack meaning. As a result, it is not always
easy to determine if (or when) a trauma-informed approach
is being implemented and, importantly, if it might be
* Catia G. Malvaso
catia.malvaso@adelaide.edu.au
Andrew Day
day.a@unimelb.edu.au
Carolyn M. Boyd
carolyn.boyd@adelaide.edu.au
1 School ofPsychology, The University ofAdelaide, Adelaide,
SouthAustralia, Australia
2 School ofPublic Health, The University ofAdelaide,
Adelaide, SouthAustralia, Australia
3 School ofSocial andPolitical Sciences, The University
ofMelbourne, Parkville, Victoria, Australia
4 Swinburne University ofTechnology, Hawthorn, Victoria,
Australia
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940 Journal of Child & Adolescent Trauma (2024) 17:939–955
expected to lead to a reduction in clinically significant symp-
toms of trauma, to improvement in the wellbeing of justice-
involved young people, and/or to a reduction in subsequent
offending and other justice-related outcomes (Homes&
Grandison, 2022). In this paper our aim is to provide an
up-to-date summary of the current evidence relating to the
outcomes of trauma-informed youth justice. This, we sug-
gest, should be relevant information for policymakers when
considering this approach, and serve to strengthen public
confidence that trauma-informed models of service delivery
will result in the desired outcomes of a justice agency.
Trauma‑Informed Youth Justice
Youth justice agencies typically strive to achieve different,
but overlapping, aims. In Australia, for example, the federal
government requires that youth justice services aim to pro-
mote community safety, to rehabilitate, and to reintegrate
young people who offend, as well as to contribute to a reduc-
tion in youth re-offending (Report on Government Services,
2022). Thus, while the management of risk of reoffending
is clearly a priority for all criminal justice agencies, there
is also an expectation that the welfare of the child or young
person should be protected and promoted. It is in relation to
this philosophical change in how the community views its
responsibilities towards justice-involved children and young
people that interest in trauma-informed policy and practice
has grown rapidly, with countries such as England and Wales
now prioritizing child welfare over justice considerations
(Haines & Case, 2015).
A trauma-informed approach is a universal approach
that, at its core, is designed to do no further harm to those
who have experienced traumatic life events (Liddle etal.,
2016). The assumptions that underpin trauma-informed
youth justice are, as a result, somewhat different from those
that provide the foundation for the delivery of more tradi-
tional criminal justice services. As Griffin etal. (2012) have
argued, trauma-informed work does not distinguish between
‘victim’ and ‘perpetrator’ in the same way that many western
legal systems do; rather, ‘risk’ is conceptualized in terms
of vulnerabilities that arise in response to childhood mal-
treatment and social and structural inequalities. Hence, the
primary goal of service delivery is to provide an environ-
ment in which the impacts of maltreatment and adversity
are acknowledged, processed, and resolved. A primary con-
cern is to minimize exposure to potentially retraumatizing
events. Thus, trauma-informed youth justice is not simply
concerned with the provision of mental health services that
address symptoms of trauma (this is usually referred to as
‘trauma-focused’ intervention and relates primarily to the
provision of mental health treatment), but also to mitigate
the risk of young people behaving, or being treated, in ways
that re-traumatize or cause harm to others or to themselves
(Buckingham, 2016). One way that youth justice agencies
have sought to reduce re-traumatization, for example, is
to provide a structured and safe environment (e.g., regu-
lar meals, bedtimes, school times, expectations of behav-
ior) such that basic psychological and health needs are met
(Skuse & Matthew, 2015).
The rationale for implementing trauma-informed practice
is derived, in part, from research showing that many justice-
involved children and young people have experienced – and
may continue to experience – maltreatment and adversity.
It is now well-established that across all youth justice sys-
tems, most children and young people will have a history
of (often extensive) child protection system contact (see
Lamers-Winkelman etal., 2012; Spinhoven etal., 2010),
with experiences of victimization in childhood associated
with both clinically significant symptoms of trauma (Mal-
vaso etal., 2022) and offending (Berg & Schreck, 2022).
In a recent review, for example, Yoder and Tunstall (2022)
reported that as trauma exposure accumulates over time, so
too do high-risk behaviors and contacts with the youth jus-
tice system (see also Layne etal., 2014).
There has been considerable interest in understanding
the developmental pathways that result in offending. As
de Ruiter etal. (2022) observed in their discussion of how
maltreatment and trauma can increase risk, one possible
mechanism is that the emotional numbing and feeling
of detachment that often results from trauma leads
to increases in callousness and disregard for victims.
Another hypothesis is that exposure to traumatic stressors
compromises secure attachment with primary caregivers,
resulting in self-regulatory deficits that facilitate offending
(Ford etal., 2012a, b). Alternatively, the degree to which
maltreatment represents a ‘betrayal’ of trust may influence
the way in which abuse-related information is processed
and remembered and trigger antisocial behavior. Another
consideration is the way in which systemic interventions
mitigate or exacerbate trauma systems, such as the placement
of children who have experienced maltreatment into out-of-
home care. Placement in residential care facilities is known
to exacerbate trauma symptoms and associated behavioral
problems which, in turn, may lead to an increased risk of
contact with the justice system (Malvaso & Delfabbro, 2015;
Ryan etal., 2008).
The broad conclusion that can be drawn here is not only
that trauma reactions are often a catalyst for involvement
in the criminal justice system, but that they can also act to
increase the risk of offending and re-offending (see Becker
& Kerig, 2011; Craig etal., 2017; Ford etal., 2010). Put
simply, the key presentations of trauma (e.g., impulsiv-
ity, risk-taking, and low self-control) represent important
criminogenic needs (or ‘dynamic risk factors’; see Klepfisz
etal., 2016), and should thus form important intervention
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941Journal of Child & Adolescent Trauma (2024) 17:939–955
targets for any service that aims to reduce re-offending (see
Ford etal., 2007). It follows perhaps that a logical service
response is not to ‘punish’ justice-involved young people and
implement measures that deter them and others from offend-
ing, but to offer a more therapeutically aligned approach that
helps children to feel safe and to gain control over intense
reactions, destructive thoughts, and impulsive behaviors.
The key point here, however, is that the aim of trauma-
informed youth justice is, inevitably, to achieve multiple
outcomes – and these include reducing trauma symptoms,
promoting good mental health and wellbeing and reducing
externalizing and offending behaviors.
Given that a trauma-informed youth justice will aim to
influence different, and potentially conflicting, outcomes,
there is a need for clarity about the processes, activities,
and interventions that will best achieve these goals. In
response to concerns that trauma-informed approaches
to youth justice lack coherence, Branson and colleagues
(2017) published a systematic review that identified core
elements of service delivery as well as offering comprehen-
sive recommendations for implementation and evaluation.
Three domains of recommended practices were identified:
(1) clinical services for youth involved in the justice sys-
tem (screening and assessment, trauma-focused treatment,
cultural competence); (2) agency context (young person
and family engagement, workforce development, provid-
ing a safe environment, agency policies, procedures, and
leadership); and (3) systems level (systems policy and pro-
cedures, cross-agency collaboration, quality assurance and
evaluation). Branson etal. (2017) also recommended further
research to establish which, if any, of these practices are
effective in relation to both wellbeing and justice-related
outcomes for children and young people. Since then, a series
of systematic reviews and meta-analyses have been pub-
lished that share a common aim of synthesizing the available
evidence on trauma-informed approaches to youth justice.
Each of these has a slightly different focus and, given the
multiple components of a trauma-informed approach, the
current evidentiary standing of trauma-informed programs,
service delivery, and policy frameworks across youth justice
is not easy to ascertain. This creates challenges for policy
makers and practitioners who are seeking new and different
ways of working. Accordingly, the purpose of this study is to
curate current evidence to arrive at an overall assessment of
this relatively new approach to youth justice service delivery.
Method
An umbrella review methodology was used in this study to
curate knowledge from systematic reviews and meta-anal-
yses to determine the overall strength of evidence on a par-
ticular topic (Pollock etal., 2020). It is a structured approach
that utilizes the Preferred Reporting Items for Systematic
Reviews and Meta-analysis (PRISMA) statement (Page
etal., 2021) and involves an assessment of the methodologi-
cal quality of the reviews considered before summarizing
the evidence. It also aids identification of differences in how
reviews evaluate overlapping primary studies and interven-
tions (Pollock etal., 2020). As all analyses reported in this
study were based on previous published studies, no ethics
approvals or participant consents were required.
Search Strategy andInclusion Criteria
To locate eligible studies, searches were conducted of the
following databases: PsycINFO; PubMedCentral; Embase;
Criminal Justice Abstracts with Full Text (EBSCOhost);
ProQuest (Social Science Premium Collection); and CINCH
Australian Criminology Database. We also searched the
Cochrane Database of Systematic Reviews, the Campbell
Collaboration, and PROSPERO International prospective
register of systematic reviews. Given varying definitions
and conceptualizations of trauma-informed practice, our
search terms were intentionally broad to identify a range of
relevant reviews, including those that while not labelled as
‘trauma-informed’ nonetheless included studies of trauma-
informed or trauma-focused practices and interventions.
To illustrate, the following search terms were entered into
the PsycINFO data base, and adapted for other databases
as necessary: “juvenile justice or juvenile delinquency/ or
((youth or juvenile or young or adolescen* or minor) adj3
(justice* or justice-involved or justice involved or court* or
detention* or delinquen* or incarcerated or incarceration or
correction* or offend* or custody)) and trauma-informed
care.sh or exp treatment/ or exp treatment outcomes/ or
(trauma* adj (informed or focused or responsive or oriented
or specific)) and (systematic review or meta analy* or meta-
analy*)”. Searches were conducted between October 2022
and April 2023.
To be included, a review had to have included at least
one quantitative evaluation of a trauma-informed, or trauma-
focused, group-based intervention aimed at improving out-
comes for a justice-involved youth population (i.e., young
people who were currently involved with the justice system,
aged between 10 and 24years, with at least some partici-
pants under the age of 18). The review had to be in the Eng-
lish language, peer-reviewed, and published in a five-year
period following Branson etal.’s (2017) systematic review,
with purely theoretical or policy-focused articles excluded.
Reviews that involved only qualitative studies, individual
case studies, or evaluations of the impact of a therapeutic
environment in non-youth justice settings were also excluded.
Given the scarcity of randomized studies in this field, reviews
of randomized and non-randomized studies were included.
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942 Journal of Child & Adolescent Trauma (2024) 17:939–955
Data Extraction andManagement
Review selection was undertaken by two authors using the
Covidence systematic review software (Covidence, 2022).
After removing duplicate records, the same two authors
independently screened abstracts and read the full-text
articles. Where there was disagreement, discussion ensued
until full agreement was reached. The PRISMA flow chart
of study selection can be found in Fig.1.
Each review was independently coded, with reference to
a template designed to describe key features and to report
the main findings. The coding form examined several con-
tent areas: author and review descriptors (e.g., authors,
year); sample descriptors (e.g., population, age range, inter-
vention); design; conclusions; outcome (trauma symptoms,
other mental health outcomes, and justice-related outcomes
such as re-offending and institutional behavior); and a sum-
mary of key analyses/findings and review conclusions.
PICO information (population, intervention, comparator,
outcome) from the primary studies included in each review
was also recorded, as recommended by Pollock etal., 2020.
All authors consulted regularly during this process.
Two authors then assessed the reviews against the
AMSTAR 2 quality indicators (Shea etal., 2017). Based
on the original AMSTAR for quality assessment of sys-
tematic reviews of randomized studies (Shea etal., 2007),
AMSTAR 2 incorporates additional items to address the
greater susceptibility of non-randomized studies of inter-
ventions (NSRI) to bias, compared with randomized stud-
ies. Of the 16 items, three are specific to meta-analyses.
Fig. 1 Flow chart of the study
selection process
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943Journal of Child & Adolescent Trauma (2024) 17:939–955
Data Synthesis
A brief narrative description of each review was then
produced, synthesizing the main findings relating to three
principal outcome domains of trauma-informed youth justice
(trauma symptomatology, mental health and wellbeing, and
justice-related outcomes).
Results
Description ofIncluded Reviews
Nine systematic reviews – three meta-analyses and six nar-
rative reviews – met our inclusion criteria. Justice-involved
children and young people were the target population in
five of these reviews, while studies involving both justice-
involved and non-justice-involved children and young people
populations (such as at-risk youth or youth in psychiatric set-
tings) were included in the remainder. Only findings related
to group-based evaluations of interventions provided in jus-
tice-involved youth populations are reported in this study.
A summary of the main characteristics of each review is
presented in Table1.
The nine reviews encompassed a total of 47 group-based
juvenile justice-related primary studies (1 to 14 per review),
with 15 of the primary studies included in more than one
review (see Table S1 in the supplementary material).
Accounting for duplicates (n = 2245), there were 8615 par-
ticipants (n = 30 to n = 5469 justice-involved young people
per review). Most participants were male, and ages ranged
from 11 to 24years. All nine reviews included one or more
controlled studies (i.e., randomized, or quasi-experimental
designs with comparison group). Seven of the reviews also
included group studies without a comparison group (e.g.,
single-group, pretest–posttest), and two included individual
case studies. The sample size of primary studies included in
each review ranged from n = 9 to n = 3068.
In total, 41 named interventions targeting outcomes rel-
evant to justice-involved youth were evaluated. Among these
were 29 group-based manualized programs, of which the
majority were psychological treatments, either based on cog-
nitive-behavioral therapy (CBT) or incorporating elements
of it. Among the trauma-specific elements of treatment were
psychoeducation about trauma and its effects on psychoso-
cial development and emotion regulation; skill development
in self-awareness, emotion regulation; mindfulness and med-
itation training; processing trauma-related memories (e.g.,
through trauma narratives); sensory processing; and dealing
with future trauma. One intervention focused on organiza-
tional transformation. Most of the psychological interven-
tions also included therapist training prior to delivering
treatment. In only a few cases, however, was a specific staff
training program named as a component of the intervention.
Methodological Quality
The results of the AMSTAR 2 assessment of methodological
quality are reported in Table2. Generally, studies wholly or
partially met four of the criteria: specifying PICO character-
istics in their inclusion criteria, using a comprehensive lit-
erature search strategy, reporting studies in sufficient detail,
and reporting funding and/or conflicts of interest. However,
no study fully met all criteria, as none provided a list of
excluded studies with reasons for exclusion or reported fund-
ing information for all included primary studies. The reviews
differed in terms of whether they had developed an a priori
review protocol, provided an explanation for selection of
study designs, performed study selection and data extrac-
tion in duplicate, or formally assessed sources of individual
study bias. Several reviews attained only a ‘partial yes’ for
adequate primary study description because design features,
such as the number of groups or the type of control condition
were unclear. Studies also varied in the completeness with
which they reported relevant aspects of sample characteris-
tics such as racial composition, and mental health diagno-
sis. All but one of the reviews had undertaken some form
of quality assessment. Five (Gagnon etal., 2022; Givens
etal., 2021; Hodgkinson etal., 2021; Kumm etal., 2019;
Rhoden etal., 2019) evaluated primary studies against exist-
ing assessment tools, while two (Baetz etal., 2022; Rhoden
etal., 2019) assessed sources of bias using the Cochrane
Risk of Bias tool. One meta-analysis assessed the reliability
and validity of included outcome measures (Eadeh etal.,
2021), while another formally assessed the risk of publica-
tion bias (Olaghere etal., 2021).
Narrative Description ofMain Findings (in alphabetical
order ofreview)
Baetz etal. (2022) systematically reviewed seven controlled
studies published between 2002 and 2017 to examine the
impact of manualized, trauma-specific treatments on the
reduction of post-traumatic stress disorder (PTSD) symp-
toms, co-occurring mental health symptoms, and justice-
related outcomes in justice-involved young people. Treatment
effect sizes were calculated for PTSD. Four studies were
reported as showing a significant decrease in PTSD symp-
toms following treatment when compared with a control
group. Regarding improvement in mental health symp-
tomatology, both cognitive processing (Ahrens & Rexford,
2002) and TARGET (Marrow etal., 2012) were associated
with reductions in depressive symptoms, but in the case
of Marrow etal. it was noted that the magnitude of the
difference in outcome between the TARGET and control
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944 Journal of Child & Adolescent Trauma (2024) 17:939–955
Table 1 Key Characteristics of included reviews
Review authors, year,
type of review, country
of origin
Number of
included
studies
Number of group-
based studies with
justice-involved youth
(sample N)
Interventions Intervention orientation
and components
Outcome domain
Trauma Mental health and
wellbeing
Justice system related
outcomes
Baetz etal. (2022)
Systematic Review
US
7 7 (655) Cognitive processing
therapy; SITCAP-
ART; Think
Trauma (staff
training) + TGCT-A
(youth treatment);
TARGET (2
studies); MTFC + T;
WRITE-ON
Trauma processing;
sensory processing;
CBT; trauma affect
regulation education
& skill development;
TI environmental
modifications; TI
psychoeducation and
training; expressive
writing
PTSD symptoms Co-occurring mental
health symptoms and
disorders
Juvenile justice-related
outcomes (including
behavioral problems,
time spent in
seclusion, post-release
delinquent behavior
and/or rearrest)
Eadeh etal. (2021)
Meta-analytic review
US
31 4 (304) TARGET; Multiple
group family
intervention (2
studies); juvenile
justice anger
management for girls
Trauma affect
regulation
education and skill
development; affect
regulation and
attachment; anger
management.
- Emotion regulation;
maladaptive and
adaptive affect
regulation; positive
and negative
cognitive regulation
-
Gagnon etal. (2022)
Systematic Review
Finland/US
11 10 (1882) Think Trauma (staff
training) + STAIR
(youth therapy);
Addressing the Harm;
dialectical behavior
therapy; TF-CBT;
motivational
interviewing;
gender-responsive
programming
(vs behavioral
reinforcement);
Sanctuary®;
WRITE-ON;
social problem-
solving training;
TGCT-A (youth
therapy) + Think
Trauma (staff
training)
Trauma affect
regulation
education and
skill development;
restorative
justice; CBT;
trauma-informed
organizational
transformation;
problem solving;
trauma & grief
processing; trauma-
informed staff
training
Trauma symptoms Internalizing,
depression; affect
regulation; perceived
safety
Violent incidents
(youth); restraint and
seclusion; recidivism
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945Journal of Child & Adolescent Trauma (2024) 17:939–955
Table 1 (continued)
Review authors, year,
type of review, country
of origin
Number of
included
studies
Number of group-
based studies with
justice-involved youth
(sample N)
Interventions Intervention orientation
and components
Outcome domain
Trauma Mental health and
wellbeing
Justice system related
outcomes
Givens etal. (2021)
Systematic Review
US
19 6 (448) Meditation course;
mindfulness
training; TARGET;
aerobic exercise
training; TGCT-A
(youth) + Think
Trauma (staff);
structured group
therapy; coping
course
Mindfulness; trauma
affect regulation,
psychoeducation and
skill development;
physical fitness
training; CBT;
coping & problem-
solving; trauma &
grief processing; staff
training
- Affect-regulation;
externalizing
behaviors; mood; life
attitudes; self-esteem;
social adjustment
-
Hodgkinson etal.
(2021)
Systematic Review
UK
14 14 (5,469) Goal setting + post-
release care; re-entry
services; cognitive
training + post-release
care; decompression
treatment (2 related
studies); enhanced
thinking skills
(vs reasoning &
rehabilitation); Two
intensive regimes
for young offenders;
TARGET; Teen
Court; diversion
program; Re-ART;
computerized
training in negative
emotion recognition;
cognitive intervention
program; values-
based therapeutic
environment
A diverse range
of psychological
treatments aimed
at developing
psychological
resilience in serious
juvenile offenders.
Components
include CBT;
positive behavioral
reinforcement;
intensive fitness
training, vocational
training, emotion
recognition;
problem-solving
and goal setting;
negative behavioral
reinforcement
- Psychological
measures of
resilience, emotion
regulation, dynamic
risk factors, self-
esteem, sense of self,
sense of coherence;
psychopathy
Reoffending and
related outcomes
(frequency and
severity of offending;
time to reoffending;
completion of
community sentences)
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946 Journal of Child & Adolescent Trauma (2024) 17:939–955
Table 1 (continued)
Review authors, year,
type of review, country
of origin
Number of
included
studies
Number of group-
based studies with
justice-involved youth
(sample N)
Interventions Intervention orientation
and components
Outcome domain
Trauma Mental health and
wellbeing
Justice system related
outcomes
Kumm etal. (2019)
Meta-analytic review
US
11 11 (821) Cognitive processing
therapy; dialectical
behavior therapy;
psychoeducational
group intervention(2
unrelated studies);
CBT; social
problem-solving
training; attributional
retraining;
TARGET; TGCT-A
(youth) + Think
Trauma (staff
training); coping
course; animal
assisted therapy
Cognitive processing
and cognitive
behavioral therapy;
psychoeducation;
affect regulation
(including distress
tolerance); coping
and problem-solving;
animal therapy
PTSD Anxiety, depression,
internalizing
behavior
-
Olaghere etal. (2021)
Meta-analysis
US
30 6 (393) Cognitive processing
therapy; TARGET
(2 studies); MTFC;
image rehearsal
therapy; Sanctuary
Model®
Cognitive processing,
trauma affect
regulation,
psychoeducation and
skill development;
TI environmental
modification; CBT
and behavioral
reinforcement;
trauma processing;
trauma-informed
organizational
transformation and
psychoeducation
PTSD and related
symptoms
Affective outcomes;
hope
Delinquent behavior
Purtle (2020)
Systematic Review
US
23 1 (30) Sanctuary Model Trauma-informed
organizational
transformation
- Physical and perceived
safety of youth and
staff
-
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947Journal of Child & Adolescent Trauma (2024) 17:939–955
CBT cognitive-behavioral therapy, EMDR eye movement desensitization and reprocessing, MASTR Motivation-Adaptive Skills-Trauma Resolution, MTFC Multidimensional Treatment Foster
Care, MTFC + T Multidimensional Treatment Foster Care plus Trauma, RE-ART Responsive Aggression Regulation Therapy (Outpatient), SITCAP-ART Structured Sensory Intervention for
Traumatized Children, Adolescents and Parents – Adjudicated and at Risk Youth, SPARCS Structured Psychotherapy for Adolescents Responding to Chronic Stress, TARGET Trauma Affect
Regulation: Guide for Education and Therapy, TF-CBT trauma-focused cognitive behavioral therapy, TGCT-A Trauma and Grief Component Therapy-Adolescent, TI trauma-informed, WRITE-
ON Writing and Reflecting on Identity To Empower Ourselves as Narrators, PTSD posttraumatic stress disorder
Review authors, year,
type of review, country
of origin
Number of
included
studies
Number of group-
based studies with
justice-involved youth
(sample N)
Interventions Intervention orientation
and components
Outcome domain
Trauma Mental health and
wellbeing
Justice system related
outcomes
Rhoden etal. (2019)
Systematic Review
US
14 12 (995) Cognitive processing
therapy; TF-CBT
training (staff
training) + TFCBT
(youth); TARGET
(3 studies);
MASTR; SPARCS;
prolonged exposure;
image rehearsal
therapy; structured
group therapy;
psychoeducational
group therapy;
SITCAP-ART;
EMDR; MTFC + T
Cognitive processing;
CBT; exposure;
trauma processing;
sensory processing;
eye movement
desensitization;
trauma affect
regulation,
psychoeducation and
skill development;
trauma-informed
environmental
modification; goal
setting, behavioral
reinforcement
PTSD symptoms - -
Table 1 (continued)
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948 Journal of Child & Adolescent Trauma (2024) 17:939–955
groups may have reflected an increase in depression in the
control group. The two studies that examined recidivism
produced conflicting results, with Multidimensional Treat-
ment Foster Care plus Trauma (MTFC + T; Smith etal.,
2012) showing reductions in delinquency and recidivism
in adolescent girls, and TARGET (Ford & Hawke, 2012)
showing no differences in rearrests between the treatment
and control groups. Baetz etal. suggested that the differing
results may have reflected differences in how recidivism
was operationalized, as well as greater follow-up care in
the Smith etal. study.
Overall, Baetz etal.’s (2022) review concluded that evi-
dence for the effectiveness of trauma specific treatments
with young people in justice settings was encouraging
(p. 650) However, the review also noted a lack of meth-
odologically sound studies, along with several challenging
aspects of implementation. These included integrating new
treatments into existing practices; engaging stakeholders;
monitoring treatment fidelity; and ensuring that daily care
staff in secure settings are adequately trained and involved
in program delivery. Potential sources of study bias that
were identified included a high risk of incomplete outcome
reporting and/or selective reporting. The authors advised
that the results of the respective studies should be interpreted
with caution.
Eadeh etal. (2021) conducted a meta-analytic review of
evidence from 41 studies of the effects of emotion regulation
interventions in adolescents with a wide range of presenting
disorders, including trauma. The underlying premise was
that a lack of adaptive emotion regulation strategies and a
reliance on maladaptive strategies are risk factors for the
development of internalizing and externalizing disorders
that are linked to poor adolescent outcomes. Gross’s (1998,
2015) model (identifying emotional responses to situations,
and selecting and implementing strategies to manage them)
was used to conceptualize emotion regulation.
Four of the studies reviewed (two randomized control tri-
als and two single-group studies) focused on incarcerated and
delinquent adolescents. Where data were available, Hedges’
g was used to calculate intervention effects (Keiley, 2007, did
not provide means and standard deviations for the outcomes,
so the original results were reported). Three studies were
reported as showing significant improvements following
theemotion regulation interventions. Keiley (2007) reported
significant decreases in incarcerated adolescents’ self- and
maternal caregiver reports of maladaptive emotion regula-
tion following participation in a multiple-group family inter-
vention (MGFI) program (fathers’ reports did not improve).
Keiley and colleagues (2015) found similar improvements
following implementation of MGFI in a sample of male
Table 2 AMSTAR 2 Ratings of included reviews
Domains: 1 = Did the research questions and inclusion criteria for the review include the components of PICO?; 2 = Did the report of the review
contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any signifi-
cant deviations from the protocol?; 3 = Did the review authors explain their selection of the study designs for inclusion in the review? 4 = Did
the review authors use a comprehensive literature search strategy?; 5 = Did the review authors perform study selection in duplicate?; 6 = Did the
review authors perform data extraction in duplicate?; 7 = Did the review authors provide a list of excluded studies and justify the exclusions?;
8 = Did the review authors describe the included studies in adequate detail?; 9 = Did the review authors use a satisfactory technique for assessing
the risk of bias (RoB) in individual studies that were included in the review?; 10 = Did the review authors report on the sources of funding for
the studies included in the review?; 11 = If meta-analysis was performed did the review authors use appropriate methods for statistical combi-
nation of results?; 12 = If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the
results of the meta-analysis or other evidence synthesis?; 13 = Did the review authors account for RoB in individual studies when interpreting/
discussing the results of the review?; 14 = Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity
observed in the results of the review?; 15 = If they performed quantitative synthesis did the review authors carry out an adequate investigation
of publication bias (small study bias) and discuss its likely impact on the results of the review?; 16 = Did the review authors report any potential
sources of conflict of interest, including any funding they received for conducting the review?
Answers: Y Yes, PY Partial Yes, N No, NMA No meta-analysis conducted, NR Not reported
AMSTAR 2 Rating Domains
Review First Author 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Baetz etal. (2022)Y Y Y Y Y Y N Y Y N NMA NMA PY Y NMA Y
Eadeh etal. (2021)Y PY N PY NR NR N PY N N Y N PY Y N Y
Gagnon etal. (2022)Y PY N PY NR Y N PY N N NMA NMA N N NMA Y
Givens etal. (2021)Y Y PY PY NR NR N PY PY N NMA NMA N Y NMA Y
Hodgkinson etal. (2021)Y N PY Y Y NR N PY PY N NMA NMA N Y N Y
Kumm etal. (2019)Y PY Y Y Y Y N PY N N PY N PY N N N
Olaghere etal. (2021)Y PY PY Y NR NR N PY NR N Y Y Y Y Y Y
Purtle (2020)N N N PY N N N PY N N NMA NMA Y N NMA y
Rhoden etal. (2019)Y N N Y N NR N Y Y N NMA NMA Y Y NMA Y
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949Journal of Child & Adolescent Trauma (2024) 17:939–955
adolescent sexual offenders. Ford etal. (2012a, b) found that
TARGET was associated with a significant reduction com-
pared with treatment as usual in negative emotion regulation
in girls placed in a juvenile justice facility. A fourth study,
evaluating a juvenile justice anger management intervention
for girls, was reported as not delivering improvements in
emotion regulation compared with treatment as usual (Riggs
Romaine etal., 2018).
Results from the three studies with calculated effect
sizes were included in the pooled effect size analysis across
all studies. Results showed significant positive treatment
effects for both maladaptive (negative) and adaptive (posi-
tive) emotion regulation strategies, albeit that there was
considerable heterogeneity and effects were small. The
authors determined that studies involving clinical samples
demonstrated larger treatment effects than those involv-
ing non-clinical samples, and this was the case for both
single-group and controlled studies. Accordingly, they rec-
ommended that future research should include more ‘meth-
odologically rigorous comparison groups’ (p. 701). The
authors also recommended increased inclusion of measures
that detect changes in the use of positive emotion regulation
and coping strategies.
Gagnon etal.’s (2022) systematic review considered
evaluations of mental health interventions for incarcerated
young people. Only primary studies published since the
release of Guiding Principles for Providing High-Quality
Education in Juvenile Justice Secure Care Settings (U.S.
Departments of Justice and Education, 2014) were included.
Eleven studies met the authors’ inclusion criteria, of which
ten were quantitative, group-based studies. Although the
included interventions varied in emphasis, most incorporated
elements of CBT. An exception was the Sanctuary program,
which aims to promote a safe and therapeutic environment
through organizational transformation, and staff education
and training (Elwyn etal., 2015). Two of the CBT-based
interventions also included a component of staff trauma
training (see TableS1 in the supplementary material for this
review), but staff outcomes were not reported. Outcomes
studied included mental health symptoms (posttraumatic
stress disorder, depression), justice-related outcomes (insti-
tutional violence, recidivism, institutional safety), and per-
sonal growth (resilience, changes in dynamic risk and pro-
tective factors). Positive main effects for at least one of the
studied outcomes in each study were reported for seven of
the ten interventions. For two of the remaining three, mod-
erator analyses showed that interventions were effective for
some participants, but not others. Specifically, a motivational
interviewing intervention for incarcerated girls was associ-
ated with reduced substance-related predatory aggression in
girls with lower, but not higher, levels of depression, while
social problem-solving training was associated with reduced
depressive symptoms in males with higher intelligence but
appeared to exacerbate symptoms in those with less high
intelligence. One quasi-experimental study of the effect of a
restorative justice program on criminogenic risk and protec-
tive factors was reported as indicating no superior effect of
assignment to the treatment program over assignment to a
control condition in which participants watched a series of
short victim impact videos. However, treatment completers
showed improved skills in impulsivity control and in deal-
ing with their own and others’ feelings. Overall, treatment
effects appeared to be stronger for males than females. The
study’s high attrition rate was noted (Gagnon etal.).
Despite noting multiple methodological shortcomings
across the reviewed studies, Gagnon etal. (2022) recom-
mended four treatments for use in youth justice facilities —
trauma-focused CBT, motivational interviewing, trauma and
grief component therapy, and dialectical behavior therapy —
as having a prior evidence base in non-youth justice popu-
lations, as well as demonstrating a positive outcome in the
reviewed studies. However, as indicated above, motivational
interviewing did not reduce predatory aggression in all par-
ticipants; rather, it only reduced aggression among those
girls with low levels of depressive symptomatology. This
finding – as well as the results of other moderator analyses
noted above—underscores the need to consider individual
differences when selecting treatments for justice-involved
youth. Sanctuary, dialectical behavior therapy, the Think
Trauma staff training program, and STAIR were also cau-
tiously recommended for further study and evaluation, while
a gender-responsive program and the restorative justice
program described above were not (the latter based on the
assignment to treatment results reported above). The authors
noted the need to establish confidence in treatment integrity
and the need for stronger research methodology.
Givens etal. (2021) conducted a systematic review of
original studies carried out in the United States and deter-
mined to be valid using National Institutes of Health study
quality assessment tools. Of 19 identified original studies,
six (published between 1988 and 2018) were conducted in
youth correctional facilities. Interventions included CBT
and its variations, as well as intensive mindfulness medi-
tation, physical exercise training, TARGET, and coping
skill training. All the cognitive-behavioral interventions
resulted in significant reductions in posttraumatic stress
disorder, while TARGET and physical exercise training
were associated with improved mood, and coping train-
ing was associated with improved self-esteem, reduced
externalizing, and reduced death-related life attitudes. The
effect of the intensive mindfulness meditation interven-
tion (a seven-hour meditation retreat) was reported as not
being significant. However, in the latter study, the control
group, as well as the intervention group, was assigned to
a ten-session mindfulness meditation curriculum, follow-
ing which the combined results of both groups showed
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950 Journal of Child & Adolescent Trauma (2024) 17:939–955
an overall improvement in self-regulation. The review
authors concluded that the variety of interventions, out-
comes, study settings, and implementation procedures
made efforts to synthesize the evidence difficult.
Hodgkinson et al. (2021) systematically reviewed
14 studies, published between 2001 and 2018, which
had documented reductions in recidivism among repeat
youth offenders following implementation of psychologi-
cal resilience interventions. This review includes stud-
ies from Europe as well as the US. The review authors
emphasized the role of childhood trauma in impeding
cognitive and emotional development in young people,
leading to high levels of negative emotions and reactivity
in those who subsequently become involved in the justice
system. They further argue that psychological resilience
may act as a protective factor against the risk of offend-
ing among adolescents who have experienced childhood
trauma, while interventions that are explicitly designed to
promote psychological resilience among youth who have
already offended could be effective in reducing their risk
of re-offending.
A wide range of treatments (see Table1) was reviewed,
including one explicitly trauma-informed program
(TARGET; Ford & Hawke, 2012). Among the mechanisms
considered responsible for positive treatment effects were
an improved sense of coherence and an increased capacity
to recognize emotions in others, since post-intervention
improvements in these aspects of resilience were associated
with observed reductions in reoffending. An increased sense
of empowerment and improved decision-making in young
people were also suggested as possible explanations.
Kumm etal. (2019) conducted a meta-analytic review
of mental health interventions in juvenile justice facilities
for young people with internalizing disorders. Eleven stud-
ies published between 1993 and 2017 were identified, of
which seven included a control group (including four ran-
domized control trials), and four employed a single-group,
pretest–posttest design. In addition to CBT, dialectical
behavior therapy, and TARGET, the interventions reviewed
included animal assisted therapy and attributional retraining.
Effect sizes with confidence intervals for individual stud-
ies were calculated, and meta-analyses of pooled effects
were carried out. No interventions in studies with a control
condition were associated with significant treatment effects
on any outcomes. However, meta-analyses of single-group
studies showed significant positive effects of treatment on
internalizing symptoms, trauma, and depression, although
not on anxiety. Review authors highlighted several meth-
odological limitations associated with single-group studies
(such as confounding the effect of time with the effect of
treatment on the outcomes) and recommended that results be
interpreted with caution. They also highlighted the need for
more rigorous research and monitoring of treatment fidelity
and recommended exploration of innovative study designs
and interventions that cater better for short-stay residents.
Olaghere etal.’s (2021) meta-analysis and accompanying
technical report (Wilson etal., 2018) reported on outcomes
following the delivery of trauma-informed interventions in
controlled studies of young people identified as atrisk of
justice involvement(23 studies) or justice-involved (six stud-
ies). The results of the six juvenile justice-related studies
were reported separately from those for at-risk young people.
Interventions examined were TARGET (Ford etal., 2012a, b;
Marrow etal., 2012), cognitive processing therapy (Ahrens
& Rexford, 2002), Multidimensional Treatment Foster Care
(Chamberlain etal., 2007), Image Rehearsal Therapy (Krakow
etal., 2001), and a version of Sanctuary that included program-
ming for young people (Rivard etal., 2003) as well as tech-
niques for therapeutic organizational transformation. For each
study, standardized mean difference effect sizes for the out-
comes were calculated (see Wilson etal., 2018, for full details)
and were subsequently combined in meta-analyses. Confidence
intervals (95%) and heterogeneity statistics were also reported.
Outcome domains included PTSD and trauma symptoms,
affect (mental health), justice (delinquency, restraint), and
hope. Three of four studies examining PTSD-related out-
comes were reported as having a near null average effect
size, with the remaining study (Krakow etal., 2001) observ-
ing a very large effect (g > 1.00) in a small sample. The
meta-analytic means for PTSD outcomes and affect were
reported as positive and small. One study that examined
justice-related outcomes (Chamberlain etal., 2007) found
that trauma treatment was associated with fewer criminal
referrals and days locked up in an institution (Wilson etal.,
2018); however, when these measures were combined with
self-reported measures of delinquency in the same study, the
resulting effect of trauma treatment was reported as essen-
tially null (p. 1267). The other study that examined justice
outcomes (Ford etal., 2012a, b) indicated slightly negative
effects of TARGET on Child Behavior Checklist measures
of delinquency, aggression, and externalizing behaviors.
Overall, based on a small number of studies, Olaghere
etal. (2021) concluded that evidence that trauma-informed
programs improve outcomes for justice-involved youth is
modest and inconclusive, although nevertheless encourag-
ing (p. 1267). Two interventions (cognitive processing and
image rehearsal therapy) were named as indicating posi-
tive effects across a range of outcomes, but as previously
noted, the relevant studies had small sample sizes (Ahrens
& Rexford, 2002; Krakow etal., 2001). While the evidence
for at-risk youth was stronger, the collection of reviewed
studies overall was reported to be at high risk of publication
bias favoring studies with significant results (see Wilson
etal., 2018 for analyses). Olaghere etal. (2021) recom-
mended that high-quality randomized experimental stud-
ies be conducted in future to isolate the effects of specific
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951Journal of Child & Adolescent Trauma (2024) 17:939–955
aspects of trauma-informed interventions on outcomes for
young people who arejustice-involved or atrisk of justice
involvement.
Purtle (2020) conducted a systematic review of trauma-
informed organizational interventions with a staff training
component. Twenty-four studies, published since 2000, were
reviewed. One study, an evaluation of the Sanctuary Model,
was conducted in a juvenile justice facility for girls (Elwyn
etal., 2015), with the remainder being conducted in child
welfare, health, residential care, and educational settings.
The review concluded that Sanctuary resulted in improve-
ments to physical and perceived safety for both staff and
young people, but that its multifaceted approach made it
difficult to isolate the effect of staff training.
Purtle (2020) concluded that the pool of reviewed stud-
ies offered sufficient evidence to indicate that participation
in trauma-informed staff training resulted in improvements
across a range of settings in staff knowledge, attitudes,
and behaviors regarding trauma-informed practices. How-
ever, the duration of these benefits for staff was consid-
ered unclear, as was the extent to which they would result
in improvements for clients. While noting various meth-
odological shortcomings of reviewed studies (e.g., the pre-
dominance of single group studies, failure to use validated
measures, limited or non-existent follow-up, and failure
to disentangle the effects of multiple interventions), this
review presents comprehensive recommendations to guide
future research on trauma-informed staff training and related
organizational interventions, while also summarizing the
implications for practice and policy.
Rhoden etal.’s (2019) systematic review examined peer-
reviewed studies conducted in the United States of trauma-
specific interventions among justice-involved young people
to the age of 21 with “reported traumatic exposure and/or
PTSD symptoms based on a DSM diagnosis or a standard-
ized measure” (p. 894). Sixteen studies, published between
2001 and 2016, were identified that met the inclusion cri-
teria. Of these, twelve (ten controlled studies and two with
a single-group design) were group-based with quantitative
analysis of outcomes. Cognitive-behavioral principles were
applied in most of the interventions studied, with treatment
protocols typically including an educational component,
skill-building, and self-regulation strategies. One study
investigated eye movement desensitization and reprocess-
ing therapy (EMDR).
Treatment effect sizes (Cohen’s d) were calculated based
on reanalysis of individual study data. Medium to large
effects of treatment on PTSD and/or other trauma symp-
toms were reported for nine studies, while a small effect was
reported for a tenth. Forproxy measures of externalizing
behavior (e.g., time spent in seclusion, delinquency), small
to large treatment effects were found in three studies. The
studies of EMDR and trauma-focused CBT were considered
to present the strongest evidence of treatment effectiveness
based on the review authors’ assessments of their compara-
tive methodological rigor. However, Rhoden etal. (2019)
concluded that there was insufficient high-quality evidence
to indicate that trauma interventions reduce trauma symp-
toms and externalizing behavioral problems despite their
co-occurrence.
Discussion
The main findings from this umbrella review are that the
provision of trauma-focused interventions is associated with
a decrease in trauma symptoms in justice-involved popula-
tions (with cognitive-behavioral approaches receiving the
strongest empirical support), as well as with improvement in
co-occurring mental health problems. There is also evidence
of a positive impact on different metrics of re-offending
and institutional misconduct. Based on our reading of the
available evidence, this offers a sufficiently strong ration-
ale to provide trauma-informed interventions to the broader
youth justice population. This advice, while not particu-
larly surprising (given that most of the review authors seem
to agree), is nonetheless important in a context in which
debates are ongoing about the need to establish safety and
stabilization before trauma treatment can be provided. Con-
cerns are, for example, often expressed that non-specialist
treatment for trauma-related presentations can cause harm,
with trauma treatment services sometimes only made avail-
able through external service providers, (such as child and
adolescent mental health services) to those who meet the
diagnostic criteria for posttraumatic stress disorder. The evi-
dence reported in this study suggests that there are effective
programs and interventions that can be embedded within a
youth justice service that do not focus exclusively on treat-
ing presentations of posttraumatic stress. This is relevant
to service planning as this type of treatment is necessar-
ily focused on how exposure to a specific trauma, as a past
event, leads to a sense of current threat. From a trauma-
informed perspective, however, it is continuous actual or
threatened traumatic events that are more significant, where
an ongoing sense of threat becomes adaptive and necessary
for survival (Rosenberg etal., 2008). Thus, efforts to imple-
ment trauma-informed youth justice should extend clinical
models of service delivery to support resilience and recovery
from the wide range of adverse childhood experiences that
justice-involved young people have typically experienced.
Effectiveness is, of course, not the only way in which the
success of an intervention can be determined, with factors
such as acceptability, adoption, appropriateness, cost, feasi-
bility, fidelity, access to service, and sustainability (Brown-
son etal., 2012) as well as cultural and context-specific
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952 Journal of Child & Adolescent Trauma (2024) 17:939–955
adaptations (Yim etal., 2024) also important. The body of
research curated across these nine reviews also shows that
such approaches are indeed feasible for delivery to youth
justice populations across a range of different settings.
Limitations
An important caveat to any recommendation to implement
trauma-informed youth justice, however, is that nearly all
the review authors specifically comment on the importance
of addressing a range of implementation and integrity chal-
lenges if a stronger evidence base is to develop. They also
all note the limitations in the methodological quality of the
pool of primary studies that were included in their reviews.
For example, several reviews noted that single-group studies
tended to show greater treatment effectiveness (larger effect
sizes) than studies with a control group, reflecting possible
confounding of treatment with non-treatment effects (Eadeh
etal., 2021; Kummet al., 2019; Olaghere etal., 2021). In
addition, the finding of comparatively large treatment effects
in primary studies with small samples may indicate a pub-
lication bias through which, it is suggested, small studies
are (even) more likely than studies with larger samples to
be published because of significant findings (Hong etal.,
2020). The need for more complete reporting of study infor-
mation to overcome the possibility of selective reporting of
results is noted (Baetz etal., 2022; Olaghere etal., 2021).
While calling for greater methodological rigor, the
review authors also acknowledge the challenges that arise
when conducting evaluation research in youth justice set-
tings. Contextual factors that potentially affect the quality
of evidence available include the high turnover of children
and young people in youth justice settings, and the result-
ing impact on study attrition and sample sizes. High staff
turnover rates also mean that new staff must be trained, and
trust with children and young people re-established. Staff
turnover also contributes to poor treatment fidelity, as do
the lack of program supervision, lack of leadership, and poor
organizational support and culture.
An additional set of limitations relates to specific
aspects of the reviews themselves. One is that in a few
cases, differences in methods used to synthesize findings
produced different evaluations of the same intervention.
Two examples of this are the impact of WRITE-ON
(Greenbaum & Javdani, 2017) on shame, and the impact
of TARGET (Marrow etal., 2012) on PTSD. While such
differences may be relatively minor, they highlight the need
for the reader to exercise care when drawing conclusions.
Importantly, there were also differences between reviews
in how well they captured aspects of sample diversity such
as race and ethnicity in their descriptions of primary study
characteristics. This made it difficult to gauge how closely
the study samples resembled the wider population of
justice-involved young people in their respective countries
or regions of origin, particularly in the United States, where
most of the primary studies were conducted. An additional
limitation was that only three of the reviews included
studies from other countries or regions, such as Canada, the
UK, or Europe. There is clearly a need to extend research
into trauma-informed youth justice to other geographical
and cultural regions. And we would also note that, even
among western countries, there are differences in judicial
systems and the composition of justice-involved youth
populations. For example, in former British colonies such
as Canada, Australia, and New Zealand, it is First Nations
populations who are especially overrepresented in the
youth justice systems, reflecting the need to develop
service responses that also acknowledge a range of social
and economic disadvantages, such as poverty, social and
health inequalities, systemic racism and discrimination, and
intergenerational trauma.
Finally, this umbrella review was limited in scope by exclud-
ing non-peer-reviewed documents and other grey literature.
And, although not by design, a major focus of the available
research was on the outcomes of trauma-focused treatments and
programs, which constitute only one aspect of trauma-informed
juvenile justice practice (Branson etal., 2017).
Next Steps forAdvancing Trauma‑Informed Youth
Justice
There is an ongoing need to better understand the outcomes
of the broad range of practices that constitute trauma-
informed practice. Some kind of trauma awareness training
for staff is, for example, considered a minimum requirement
(Branson etal., 2017), and there is a consensus that to
deliver this requires adequate resourcing and sustained
organizational and system-level support, including
leadership. There are elements of training in many of the
primary studies that were included in the reviews that met
the inclusion criteria in our study, but it was not easy to
ascertain their impact on outcomes. The Elwyn et al.
(2015) study, for example, describes an organizationally
framed intervention (Sanctuary) and is featured in two
of the reviews (Gagnonet al., 2022; Purtle, 2020), while
the Marrow etal. (2012) evaluation of TARGET features
environmental modifications as well as training (i.e., it
goes beyond treatment). It is reasonable to conclude that
the evaluation of organizational, systemwide interventions in
youth justice settings is still less well developed than that of
trauma-focused treatments. Without considering the impact
of activity at every level of the organization (SAMHSA,
2014), the evaluation of specific programs is always going
to be unsatisfactory. And so, we need to think about utilizing
stronger research designs that can account for the ways in
which individual level, group level, and organizational
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953Journal of Child & Adolescent Trauma (2024) 17:939–955
level components of trauma-informed practice interact and
combine to produce the range of outcomes that youth justice
services are expected to deliver.
An obvious next step will also be to better understand
the experiences and views of young people in the youth
justice system. The SAMHSA (2014) trauma-informed
principles were reportedly developed with expert and pub-
lic input with 2000 respondents and 20,000 comments/
endorsements (Heris etal., 2022). This was a process
specifically designed to ensure that the resulting princi-
ples reflected the voices of trauma survivors, and it thus
becomes important to listen to what justice-involved
youngpeople have to say about the services they receive
(see Day etal., 2023). The task then is to find new ways to
triangulate outcome data with the experiences and insights
of justice-involved young people.
Finally, there appears to be a need to further develop
systems of audit, accountability, and accreditation to
ensure that trauma-informed youth justice is being imple-
mented in a way that can be expected to result in the
specified desired or agreed upon outcomes for young peo-
ple and the wider community. It has, for example, been
observed that the connection between activity and out-
comes is often implicit or absent in accounts of trauma-
informed practice (Bazemore, 2006) and there may well
be differences in the extent to which different parts of any
justice system align with a trauma-informed philosophy.
External youth justice stakeholders and mental health
providers who work with trauma may, for example, focus
more on symptom reduction and/or on promoting health
and wellbeing, while the principal concern of youth jus-
tice staff will typically be to reduce risk and future justice
system involvement. Our conclusion then is that, although
there is much more work to do to achieve trauma-informed
youth justice, it is a promising line of inquiry that is sup-
ported by evidence and can lead to better outcomes for
both justice-involved young people and for communities.
At a time in history when the need for new and innovative
approaches has been identified, it remains a promising
alternative to more punitive approaches.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s40653- 024- 00634-5.
Funding Open Access funding enabled and organized by CAUL
and its Member Institutions Catia Malvaso is supported by an Aus-
tralian Research Council Discovery Early Career Researcher Award
(DE200100679). This research was also supported by funding from the
South Australian Department of Human Services, Communities and
Justice, Research and Service Development Partnership Grant.
Declarations
Conflict of Interest On behalf of all authors, the corresponding author
states that there is no conflict of interest.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
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otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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